Antimicrobial resistance (AMR) is becoming a major public health crisis, reducing the chances of successfully treating people with infectious diseases – a leading cause of death in both developed and developing countries, according to the latest figures by the World Health Organization (WHO).

Bringing more effective antibiotics to the market is a key to tackling the problem. Last year, a report commissioned by the UK government estimated that, without new treatments, the 700,000 annual deaths currently caused globally by drug-resistant pathogens will increase to over 10 million by 2050.

The problem is that only two new classes of antimicrobials have been developed over the past three decades, compared with the many that were introduced in clinical practice between the 1940s and the 1970s.

Boosting R&D

So, what is the current state of the pipeline of antibiotic development? “Globally, the pharmaceutical industry is investing more aggressively in antibiotic research and development (R&D), looking at ways to restore antimicrobial activity of existing antibiotics, as well as developing new agents to treat emerging multidrug-resistant organisms,” says Dr Michael Wong, MD, global director for scientific affairs for infectious diseases at MSD, Pennsylvania, USA.

As a result, over the past few years, new antibiotics have been brought to the market, and many others are in the pipeline. So, “there has certainly been an improvement, compared with the 90s, but there is more work to do,” says Dr Wong.

Comprehensive approach

Indeed, research and development on its own is not enough to eradicate AMR. Other steps need to be taken, across countries and sectors, such as continuing to improve antibiotic surveillance, developing real-time diagnostics, and streamlining regulatory pathways to get new agents licenced faster.

“Ideally, there should be a comprehensive approach, similar to that used to tackle climate change issues, in which all stakeholders come to the table,” says Dr Wong, adding that there have already been many good steps in this direction. An example is the US GAIN Act, under which antimicrobial agents with potential against multidrug-resistant organisms are designated as Qualified Infectious Disease Products, or QIDPs. This means they can undergo expedited review by the United States Food and Drug Administration (FDA), and be brought to the market faster.

Outsmarting AMR

However, for all of the above to really work, we must bear in mind the importance of antibiotics to human health. This may seem like an obvious insight, but it is often overlooked that these drugs have saved millions of lives in the past. And they have the potential to save millions more, if we get smarter about the way we use them.

For example, there is generally little understanding, says Dr Wong, that, unlike drugs for chronic conditions such as high blood pressure or diabetes, which are taken for a lifetime, with the exception of HIV treatment, antibiotics are generally used only for short periods of time.

And not only that. According to a survey published in 2014 by Public Health England (PHE), four in ten people mistakenly believe that antibiotics are effective against viral infections, including the common cold.

As Dr Wong notes: “Antibiotics need to be recognised for their societal value, and appropriate strategies need to be deployed that optimise use of treatments, so that they are administered intelligently – in the right patient, at the right time – thereby helping to conserve their efficacy for future generations.”

Pre-antibiotic era

Another important point is that bacteria can potentially develop resistance to any antibiotic, including newly developed ones. So these, too, need to be used appropriately. There is a small but real chance, otherwise, of returning to the pre-antibiotic era, when “absolutely nothing was available to treat microbial infections,” says Dr Wong.

Positive outlook

He is, however, confident of a positive future, largely because “there are currently a number of really exciting new antimicrobial agents, which look promising for some of the most aggressive and difficult-to-treat organisms that have been in the news over the last several years.”

Dr Wong concludes that, as streamlined pathways for simplified regulatory licencing and improved diagnostics will become available, all countries, including low and middle income ones, will hopefully be able to benefit from current and future drug breakthroughs that aim to stay one step ahead of drug-resistance.